Major risks from pulmonary angiography and PE catheter thrombectomy include perforation and dissection of cardiovascular structures and of treated or untreated pulmonary arteries, with pericardial tamponade, hemothorax, and pulmonary hemorrhage as the most serious consequences. The risk of these complications during diagnostic pulmonary angiography is less than 0.5% but they may occur more frequently during pulmonary thrombectomy. Thrombectomy should only be performed in the main and lobar and not in segmental pulmonary arteries to minimize the risk of perforation or dissection. Thrombectomy should be terminated as soon as hemodynamic improvement is achieved, regardless of the angiographic result. In addition, catheter thrombectomy must be performed with surgical back-up, i.e., with immediate availability of a cardiovascular surgical team and an operating room with cardiopulmonary bypass. In case of a perforation, the interventional cardiologist will reverse or minimize anticoagulation, insert a pericardial drain, or place a balloon catheter to cover the vascular perforation site.